Because the anaesthetist and the surgeon would like to control the airway during surgical procedure, therefore, we have to share our patient's airway. It can be either an apnoea during the surgeon's turn to manipulate and have any procedure within the airway and hyperventilate by the anaesthetist when patient's oxygen saturation starts to alarm because of its downfall or this can be like an endotracheal tube but actually the rigid bronchoscope, the surgeon can perform their procedure while the anaesthetist can simultaneously ventilate the patient via a side-arm port. Besides these two ventilation technique, there is another option to ventilate the patient by using either a small calibre endotracheal tube called microlaryngeal tube which is smaller than the standard one so that the surgeon can perform some microexcision around the larynx or you can ventilate your patient using a jet ventilation which is applied by the physics principles, Bernoullie's principle, about the conservation of energy, the energy can be interchangeable in the form but overall energy is still comparable.
About the anaesthetic management it can be business as usual which is comparable to other surgical procedures when you can ventilate your patient via a small microlaryngeal tube or rigid bronchoscope, or you can employ the total intravenous anaesthesia technique to your patient. One thing to be kept in mind in airway surgery is the airway fire because sometimes the surgeon using electrocauterisation or Laser surgery which the oxygen fraction of inspired gas has to be reduced.
The airway procedure under rigid bronchoscope is shown in the above one, we employed the total intravenous anaesthesia using a new generation syringe pump called "TCI, target control infusion" in the lower photo.
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